
Anouska Longley
EC1 Clerkenwell
Chartered Counselling Psychologist, BSc (Hons) MSc AppDip HBCE
Post-natal Depression CBT group: Making the Most of Motherhood (MMOM)
There are a high percentage of women that do not seek support for this condition which may be due to stigma, fear of consequences of doing so, dysfunctional beliefs and perceptions about motherhood and ability to cope. PND exerts a negative impact upon couple relationship; development of infants; development of psycho-social problems resulting in poor social skills, reluctance to seek support, excessive self-monitoring of negative events, insufficient self-reward and excessive self-punishment. Therefore this treatment aims to improve access to mental health services and the diagnosis and support of woman experiencing PND.
Group Duration:
2 hours, 10 weeks, weekly appointments with 3 optional additional x 1 hour partner sessions in adjunct to group sessions.
Referral criteria:
Ante-natal depression (onset during pregnancy); reactive depression to birth trauma; PND/any depression detected within the first 12 months after delivery / within the first year of the youngest child’s life.
Exclusion criteria:
Bipolar disorder, psychosis or PTSD as a result of a traumatic birth; development of depressive symptoms after one year of birth and Postnatal (puerperal) psychosis.
Stats/facts:
Perinatal mental illnesses (PMI) are a range of conditions that affect at least 10% of new mothers, during pregnancy or within the first year after childbirth. Post-natal depression (PND) is most prevalent effecting 10-15% of every 100 women who give birth; Obsessive Compulsive Disorder (OCD) onset or worsening of symptoms associated with pregnancy and childbirth may be due to a hormonal change and psychological stress of pregnancy and infant care and effect 3% of new mothers; postpartum psychosis is severe mental illness affecting 2 in 1000 new mothers; PTSD is estimated at effecting 3% of mothers particularly women who have experienced childhood abuse and sexual abuse, who may experience complex feelings around becoming a parent and physical care experienced in pregnancy; paternal depression 25-50% of new fathers with depressed partners are depressed, and is shown to affect couple relationship and the developing infant; some women with a history of PMI have 50% chance of recurrence in subsequent pregnancy.
Intervention:
Psycho-education group (PEG) providing information on PND, strategies for coping with difficult child-care situations and eliciting social support; use of cognitive and behavioural techniques to tackle women’s unhelpful beliefs about motherhood and provide strategies for dealing with distress/anxiety; teaching relaxation and mindfulness; problem solving, simple behaviour activation.
Objectives:
This therapeutic group is unique in its attempt to address maternal mood & the transition to motherhood with an aim of providing social, community & peer support for both mothers & fathers (via partner assisted sessions in adjunct to group therapy sessions for mothers) along with information & education regarding PND & providing psychological therapy using CBT & Mindfulness as an integrative modality.
This therapeutic group attempts to reduce the sense of isolation, promote social inclusion, and improve access to psychological therapies such as CBT, Mindfulness, ACT, couples therapy & other interventions.
Content:
Session 1 - Behavioural Interventions
Pregnancy, birth & now
What is PND?
Strategies for improving mood
Session 2 - Pleasant activities
Psycho-education - the bio psychosocial model to PND
Psycho-education: increasing pleasant activities
Session 3 - Relaxation on the run
Psycho- education: relaxation training
Mindful parenting
Various relaxation techniques
Session 4 - Assertiveness and self esteem
Psycho- education assertive skills
Assertive/ Passive / Aggressive styles
Assertive training
Session 5 - Unrealistic expectations of parenting
Psycho-education family of origin
Psycho-education challenging unhelpful thoughts and unrealistic expectations of parenting
Session 6 - My internal dialogue
Psycho-education: self-instruction techniques
Session 7 - Developing a more helpful thinking style
Psycho-education mind games and negative thoughts
Psycho-education ways to reduce native thoughts and increase positive thoughts
Session 8 - Challenging my internal critic Challenge thoughts and feelings Psycho-education - disputing and shifting cognitive distortions
Session 9 - putting it all together
Psych-education maintaining your gains, social support & Individual exercise my goals
Session 10 - Consolidating what I have learnt
Changes in mood
Medium to long term goals
Social support
High risk situations
Life style modification
Couple session: 1 partners and PND
Introduction to PND and contributing factors
Explore fathers feelings and how life has changed since the baby
Survival tips for partners
Fathers expectations and experiences of parenthood
Partner session 2 - The couple relationship
Feedback from last session
Lovers to parents; Time for us; Time for me
Communication skills – sharing positive and negative thoughts and feelings
Session 3 partners session - doing it ourselves
Symptoms; Support; Relationship; Communication
Problem solving, negotiation
Learning outcome for clients:
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Promote Problem Solving
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Increase positive activities for pleasure and satisfaction (for self, partner & baby)
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Increase self-nurturing activities
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Learn relaxation skills
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Enhance assertiveness and communication skills
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Build support networks
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Manage anger
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Overcome Anxiety & avoidance
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Increase positive thoughts
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Decrease negative thoughts
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Challenge Unhelpful thinking patterns
Noticing & changing unhelpful thinking:
Unhelpful thinking styles / errors
1. Label thought as just one of those unhelpful thoughts
2. Stop observe think & reflect - don't get caught up in thinking process, just notice content 3. Move on & don't let thoughts stop you from what you were doing
4. Respond - increase a compassionate and non-judgmental response
5. Questions your thoughts - examples of questions
Overcoming sleep Problems
Conclusion/Ending:
If you or someone you know are experiencing PND, then access support via a health care professional or seek a support group or therapy to learn skills to manage & reduce symptoms & improve your maternal mood to make the most of motherhood.
There is an increase in paternal depression affecting 25-50 of new fathers with depressed partners. Nice guidelines recommend than women are seen within one month of assessment for PND as the effects can be devastating for mother & baby.
It is important to access treatment or support early as most women respond well to self-help, support groups, CBT & other therapies, mindfulness, ACT. If you are interested in this course or another therapeutic approach then please do not hesitate to contact me to seek individual therapy or access this group therapy.